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The author deals with certain incision techniques for the purpose of apicectomy that that are but rarely used due to their relatively limited range of indications. Furthermore, he describes and recommends two new incision techniques. The first is a variant of the V-incision at the labial frenum; the second is a Y-incision to be employed when there is a flat oral vestibule or an interfering frenulum of the cheek.
When an abnormal labial frenum causes certain complications, frenectomy should be considered. In this article, the indications for frenectomy are outlined, classical and laser frenectomy techniques are described, and the advantages and disadvantages of both techniques are discussed.
The superior lateral labial frenum is proposed as a new anatomic reference for the intraoral blocking technique of anesthesia of the anterior and middle superior alveolar nerves (infraorbital). The main advantage of this technique is the constancy of the reference point, independent of the presence or absence of teeth, which other techniques do not offer.
This study assessed the maxillomandibular relationship in temporomandibular disorders (TMD) patients, before and after short-term, flat plane bite plate therapy. It was of interest to determine the incidence and degree of mandibular deviation in a group of TMD patients and whether the mandible would shift to the midline and consequently affect reported symptoms. Seventeen female and three male subjects (age range 19-60) were included in the study. Thirteen subjects were diagnosed with myofascial pain while seven were diagnosed as exhibiting disk displacement with reduction (Research Diagnostic Criteria). After taking impressions for these subjects, casts were fabricated and mounted. Maxillomandibular relationship was evaluated by the Denar Centric Check system (Anaheim, CA). The maxillary and mandibular labial frena were used as a reference to evaluate mandibular shift. Symptom questionnaires were used to assess temporomandibular joint pain and clicking. All subjects exhibited deviation (12 subjects to the right and 8 subjects to the left) prior to bite plate therapy. After flat plane bite plate therapy, the mandibular position of all subjects shifted toward the labial frenum midline position. Based on the Binomial test, the shift was significant (p < 0.001). Measurements on the Centric Check system showed a significant movement of both condyles in the anterio-posterior plane as well as the vertical plane. There was also significant reduction in TMJ pain and clicking (p < 0.01). The results support the hypothesis that the balanced position of the mandible is with frena aligned. When occlusal obstructions are eliminated, the mandible will drift to this position.
Since 1993 the authors have been using a new approach to the treatment of the muscles intimately related with the nasal tip and the upper lip, today known as dynamic rhinoplasty. With the idea of improving the dorsum-tip-labial relationship, the dynamic rhinoplasty technique is based on performing an intraoral zetaplasty at the labial frenum, allowing the access to the local musculature, represented by the depressor septi nasi muscle and its three fascicles. Next, we perform a subperiosteal undermining of the medial bundles, releasing them from the lower nasal spine, followed by the treatment of the intermedial bundles (which substitute the former by the special kind of plication at the median line, according to the primary characteristics of the upper lip). Initially, we used the new method only for the treatment of negroid nose or for cases of exuberant droopy nasal tip. Today, with improvements in the surgical technique, it is possible to operate on almost any kind of nasolabial combination, including mouth-breather patients and even cases with long upper lip and upright nose tip. Thus, the authors have established a semiotic classification, discussing both surgical indication and technique, and also showing the importance of combining several surgical stages (septoplasty, dynamic rhinoplasty, rhinosculpture, and turbinectomy) involved in each group.
A case report of a patient who exhibited with a skeletal Class II, dental Class I malocclusion with maxillary right first molar to maxillary left first molar open bite. A hyperdivergent cranial base/mandibular plane angle is presented. Maxillary-mandibular arch form and arch width discrepancies, a low labial frenum, multiple diastemas, and mandibular dental protrusion were present. A history of thumb sucking was evident. Active tongue thrusting and inadequate tongue posture at the time of treatment were documented. The patient was treated without extraction with an 0.022-inch edgewise appliance. A modified tongue crib with a palatal button was used until stable bite closure was achieved. Ideal overbite and overjet relationships were established. A Class 1 molar and canine occlusion was obtained. The transverse discrepancy was solved, and excellent dentofacial esthetics were achieved. Posttreatment records for 38 months document the stability of the treatment result. [This case report was presented to the American Board of Orthodontics in partial fulfillment of the requirements of the certification process conducted by the Board.
Oral examinations were performed of 1021 newborn Swedish children, of whom 101 were re-examined after 2-3 or 4-5 months. The most common findings, registered in 74.9% of the children, were of oral mucosal cysts situated either palatally or on the alveolar ridges. The majority of the palatal cysts disappeared shortly after birth, and some alveolar cysts appeared after birth. Ankyloglossia was found in 2.5% of the children, and Fordyce spots in 1.0%. No natal teeth were found. The upper labial frenum was attached to the crest of the alveolar ridge in 76.7% of the children, palatally in 16.7% and buccally in 6.7%. The relationship of the alveolar ridges was recorded: the anterior segment of the mandibular ridge was distal to the maxillary in 99% of cases, and, posteriorly, the mandibular ridges were lingual to the maxillary in 97.6%. An open bite was found in 39.8% of the children.
Attached gingiva's integrity was studied with the aid of fluorescein angiography and a standardized frenal tension test in 15 subjects aged between 19 and 41 years (9 female, 6 male) with mucogingival pathology in the region of the mandibular labial frenum. Each subject showed preoperatively gingival angiographic ischemia under 200 p frenal traction. The angiographic ischemia was in no case congruent to the clinical ischemia. One month after surgical enlargement of attached gingiva (eight grafts of palatal mucosa, seven subperiosteal vestibulum extension) both mucogingival surgery techniques successfully prevented the gingival blood circulation from showing ischemia clinically as well as angiographically under 200 p frenal traction.
A nine and a half years old female school child was examined in a during routine dental examination. The patient had swelling over maxillary midline area just near the labial frenum. Both the central incisors were in position. Radiographic examination revealed presence of an inverted supernumerary tooth between the roots of the central incisors. Surgical extraction of the supernumerary was planned. A unique case of inverted (upside down) mesiodens is presented.
OBJECTIVE: The present study investigates the prevalence of oral diseases in children in the city of Oviedo (Spain). METHODS: A representative sample was selected from among the 6-year-old children in Oviedo (n= 786), involving a protocol developed for pediatric oral diseases. RESULTS: A total of 344 lesions were detected in 243 children. The most common disorder was saburral tongue (16,02%), followed by traumatisms (12.17%) and geographic tongue (4.48%). The prevalence of aphthous stomatitis was 2.24% and herpes labialis was 1,6%. Ankyloglossia was observed in 2.08% of cases, and a hypertrophic lip frenulum in 1.28%. CONCLUSIONS: In this study shows the prevalence of the lesions of the oral mucosa in the Spanish population of 6 year-old. Of the results of the present study comes off that the objectives sanitary oral publics and deprived in this field they should go focused toward: 1) the eradication of illnesses of local cause (language saburral, traumatic ulcerations, etc.) for their high prevalencia; and, 2) the precocious diagnosis of anomalies of the development (anquiloglosias and labial frenum) for their relationship with dysfunctions of the phonation and future malocclusions.
A case is presented with loss of two maxillary central incisors in a 12 year old girl due to the use of elastics around the teeth to close a median diastema. The patients complaint was an increased mobility of these teeth. She presented a Class I malocclusion and a supraposition of the upper central incisors. There was however an extreme periodontal destruction, as a consequence of which the central incisors had to be extracted. In connection with this case report considerations are made concerning the normal development of the dentition and the need for orthodontic treatment of a median diastema in the maxilla. A median diastema normally closes when the canines erupt. A hypertrophic superior labial frenum rather seems to be a consequence than a cause of a median diastema. Thus, it is no use to close a median diastema before eruption of the upper canines. If a median diastema is to be treated, use of elastics around the central incisors is contraindicated.
The legal principles involved with patient information were described from a medicolegal point of view, and practical examples (lingual anesthesia, mandibular anesthesia, rsults of detaching the labial frenum, pulpal devitalization under bridges, damage claims for incorrect treatment) were presented. The court decisions were discussed.
A midline diastema usually is part of normal dental development during the mixed dentition. However, several factors can cause a diastema that may require intervention. An enlarged labial frenum has been blamed for most persistent diastemas, but its etiologic role now is understood to represent only a small proportion of cases. Other etiologies associated with diastemas include oral habits, muscular imbalances, physical impediments, abnormal maxillary arch structure, and various dental anomalies. Effective diastema treatment requires correct diagnosis of its etiology and intervention relevant to the specific etiology. Correct diagnosis includes medical and dental histories, radiographic and clinical examinations, and possibly tooth-size evaluations. Appropriate treatment modalities have been described. Timing often is important to achieve satisfactory results. Removal of the etiologic agent usually can be initiated upon diagnosis and after sufficient development of the central incisors. Tooth movement usually is deferred until eruption of the permanent canines, but can begin early in certain cases with very large diastemas.
Congenitally missing teeth of three generations of a family and the spousal influence on the oligodontia of the third generation is investigated. For clarification, a review of commonly used terms is included in the paper. Although there are a number of factors affecting the failure to develop permanent tooth buds, most researchers believe that an autosomal dominant trait is responsible for the oligodontia in this family. Many syndromes are associated with oligodontia, but none seem to be prevalent in the direct descendants of the first generation. A member of the second generation married a person with Witkop's (tooth-and-nail) syndrome. Subsequently, their child exhibits the same manifestations. A feature noted in this three generation pedigree is missing permanent first molars. This is considered rare, especially when few abnormal ectodermal findings are reported. Additional findings include an increased number of missing teeth, decreased tooth size and a prominent maxillary labial frenum. The dental treatment for patients affected will likely involve a multidisciplinary approach. The treatment is particularly important since the lack of a full complement of teeth impacts the emotional and physical well-being of the individual. Children who are missing permanent teeth should be screened for other ectodermal abnormalities to rule out syndromes associated with congenitally missing teeth. Oligodontia is predicted to affect fifty percent of the fourth generation. It may vary in penetrance and expression.
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